PRN UR Coordinator

Arlington, Texas, United States

Job Description

The UR Coordinator is responsible for managing the treatment activities offered to the patient, including the appropriate clinical screening of admissions, interface with the treatment team / external case managers / managed care organizations and implementation and supervision of the discharge planning. Utilizaton Review coordinates with insurance companies on a daily basis to gain authorization information.

Job Functions – Case Management

      I.            Maintain ongoing direct contact with the attending practitioner, treatment coordinator, and various members of the team.

      II.            Work with the treatment team regarding the Continuum of Care Plan and collaborate with the team when changes are needed.

      III.            Ensure that the patient attends the appropriate level of care or program as indicated on the treatment plan or as needed when there are changes in the patient’s status.

      IV.            Interface with the staff of the appropriate level of care to facilitate a smooth transition at the time of transfer.

      V.            Maintain necessary documentation of all services and the quality of care.

      VI.            Assure proper tracking of all reviews.

     VII.            Maintain statistical reports and prepare documentation of significant findings.

     VIII. Communicate and enforce the documentation requirements with all levels of staff to meet accreditation and certification body requirements.

      IX.            Prepare the computer daily control sheet providing information for the intake census / planning meeting.

      X.            Initiate and update the denial log statistics on an ongoing basis maintaining current information at all times, and initiate appeals through telephone or written communication.

      XI.            Promote an effective use of resources for patients, customers and the facility with sensitivity to the cost of health care.

      XII.            Ensure that patient rights are upheld.

     XIII. Advocate for the lowest level of care consistent with patient needs.

     XIV. Function as a resource for patient / families / significant others.


Job Functions – Discharge Planning

      I.            Coordinate with the team discharge plans to the patient / family / significant other that were identified by the treatment team.

      II.            Monitor the discharge planning activities.

      III.            Organize the use of resources to keep the patient as close to home as possible, provide liaison to aftercare providers and follow up after discharge to ensure efficacy of the discharge plans. 


Job Functions – Treatment Planning

       I.            Provide support and assistance to the patient and the patient’s support system.

       II.            Review assessment information with admitting practitioners and treatment coordinator and formulate AXIS IV and V diagnosis (in consultation with the admitting practitioner).

       III.            Plan an episode of care to identify services that will be provided if the patient is moved to a greater or less intensive level of care depending on the needs of the case.

       IV.            Communicate with attending practitioner and treatment coordinator, and other providers of service, to assure continuity of care and expedite the follow of services and transition between levels of care.

        V.            Provide feedback to the attending practitioner and treatment team members concerning continuing certification of days / services.

    VI.            Communicate with external reviewers and referral sources. Conduct all needed external reviews and maintain documentation of all such interaction.

  VII.            Ensure that third-party payors are notified of, or participate in, decisions about appropriate transitions between levels of care.


Job Functions – Utilization Review

       I.            Consult with the Business Office and / or admission staff as needed to clarify data and ensure the insurance precertification process is complete.

       II.            Provide clinical precertification information to patients, managed care companies, insurance companies and other third party reviewers to establish the length of stay or number of certified days.

      III.            Coordinate with the insurance company doctor in appeals process and denials process.


 Licenses Required - RN, LMSW, LCDC, or LPC. Interns (such as LPC-Intern) are considered.


Required Education and/or Experience

Education Required

Social work, mental health, or Nursing

Type of Degree

Master’s degree

Amount of Experience

Two (2) years

Type of Experience

Direct clinical experience in a psychiatric or mental health setting. Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities


Organizational Universal Competency Requirements:

Customer Focus – Relates work and job purpose to Sundance missions and commitment to customers.

Teamwork – Interacts effectively and builds respectful relationships within and between units and among individuals.

Communication – Communicates effectively in ways that enhance productivity and build respectful relationships. Demonstrates active listening, written, verbal, and information technology skills. Shares relevant information.

Conflict Resolution – Seeks constructive approaches to resolving workplace issues.

Integrity – Adheres to high standards of personal and professional conduct.

Adapting to Change – Responds positively to change, showing willingness to learn new ways to accomplish work.

Respect for Individuals – Fosters mutual respect and supports Sundance’s commitment to diversity. Promotes community building and diversity initiatives that help employees learn and respect each other’s differences.

Safety – Contributes to a safe and secure environment for customers by following hand hygiene and other established procedures and protocols as appropriate by job function.

Quality – Adopts practices to improve work processes, enhance customer satisfaction and ensure excellence in daily work.

Efficiency – Accomplishes work in ways that maximize productivity and available resources while minimizing waste.

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